Tremor

Atypical Pakinsonism

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Atypical Pakinsonism, Atypical Parkinson's Disease, Atypical Parkinson Disease, Parkinsonism-Plus Syndrome

  • See Also
  1. Parkinson's Disease
  1. Key features of classic Parkinsonism are prominent
    1. Ataxia
    2. Bradykinesia
    3. Postural Instability
    4. Resting Tremor
    5. Rigidity
  2. Atypical Features vary depending on affected neurologic distribution
    1. Lewy Body Dementia
    2. Multiple system atrophy
    3. Cortical Basal Ganglionic Degeneration (CBGD)
    4. Progressive supranuclear palsy
  3. Distinguishing features
    1. Resting Tremor absent
    2. Refractory to Carbidopa/Levodopa
  • Signs
  • Prominent Features
  1. Cerebellar signs (dysmetria, Ataxia) with impaired gait
  2. Myoclonus
  3. Cognitive deficits (including early-onset Dementia)
  4. Hallucinations
  5. Impaired speech
  6. Urinary Incontinence
  7. Early symptomatic Postural Hypotension (Dysautonomia)
  8. Cortical Basal Ganglionic Degeneration
    1. Alien limb phenomenon (involuntary extremity motor activity while feeling the limb is detached)
  9. Upper Motor Neuron signs
    1. Axial rigidity is greater than extremity rigidity
    2. Pyramidal tract signs (hyperreflexia, weakness, spasticity, positive Babinski Sign)
  10. Progressive Supranuclear palsy (Supranuclear Gaze Palsy)
    1. Olfaction is normal
    2. Vertical Gaze Paralysis and postural instability
      1. Difficulty reading
      2. Loss of Down gaze
  • Course
  1. Early-onset Dementia
  2. Rapidly progressive course
  • References
  1. Ahlskog (2011) Mayo Internal Medicine Review Lecture
  2. Schim (2001) CMEA Medicine Lecture, San Diego
  3. Clarke (2003) Clin Evid 10:1582-98 [PubMed]
  4. Clarke (2004) Lancet Neurol 3:466-74 [PubMed]
  5. Gazewood (2013) Am Fam Physician 87(4): 267-73 [PubMed]
  6. Nutt (2005) N Engl J Med 353:1021-7 [PubMed]
  7. Olanow (2001) Neurology 56:S1-88 [PubMed]
  8. Rao (2006) Am Fam Physician 74:2046-56 [PubMed]
  9. Young (1999) Am Fam Physician 59(8):2155-67 [PubMed]